HomeMy WebLinkAboutUS SURVEY 3043 LT 13 PART 1 T10N R2E SEC 18Onsite File
Lot L 3 Part
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Development Services Department
On -Site Water &Wastewater Section
Certificate of On -Site Systems Approval
Parcel I.D. 075-092-27
1. GENERAL INFORMATION
Phone: 907-343-7904
Fax: 907-343-7997
Expiration Date: 2 - i - z O-�l
Complete legal description US SURVEY 3043 LOT 13, PART 1 TION R2E SEC 18
Location (site address) xxxx= I a 1 t,QKNN LN
Current property owner(s) 1BLXXM S us fog C NSTO N Day phone
Mailing address 3 03 LA PIR N C E I 0 IJ W Ay
Real estate agent
2. TYPE OF DWELLING:
® Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
Day phone
3. NUMBER OF BEDROOMS:
2
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Private Well
®
Private Septic
❑
Water Storage
❑
Holding Tank
❑
Community Well
❑
Community
❑
Public Water System
❑.
Public Sewer
Waiver request for: Distance:
Received by: Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ a (0 ( coy lb -1 I
Date of Payment 0�3 �o? a d
Receipt Number y
COSA# 0SCo20 0�
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based
on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the
on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of
bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the
Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater
disposal system is (are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in
effect at the time of installation. I acknowledge that On -Site staff may visit the site to verify the information submitted.
Name of Firm FIRST WATER CONSULTING Phone 907-350-9566
Address 13030 SUES WAY, ANCHORAGE, AK 99516
Engineer's Printed Name CURTIS HUFFMAN, PE Date 10/29/2020
Comments: This investigation was completed in compliance with MOA guidelines, regulations,
and best industry practices / methods. The assessment of the condition of the well and septic
applies only to the conditions as of the day tested. The flow and absorption rates may change
due to subsurface conditions that may not be observed from the surface, changes in land use,
local soil characteristics, groundwater levels that may fluctuate during the year, quality of
construction (workmanship & materials), the water usage of the family being served by the
system and maintenance. The operational life of all well and septic systems are subject to r~ OFA
these various and dynamic characteristics and are outside the control of the evaluator of the •�
well and septic system. Therefore, any estimate of how long a system will function satisfactory ��g�P• ..,9 �)
for current or future occupants or guarantee that no unseen encroachments, deficiencies or
discrepancies exist can be given by First Water Consulting & FWGs ' *� . Tl -I ` .....* �r
/ .. .. /
. .... .........
6. DSD SIGNATURE / Curtis Huffman .
System #1 Approved for bedrooms rr��c/s� . CE 128991
Fq 40/.29/2Q20
System #2 Approved for bedrooms �l(i\ PROFESSIONP�
Disapproved
Conditional approval for bedrooms, with the following stipulations:
ON-SITE
WATER AND
By: Original Certificate Date: 2000
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the
representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is
not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
Legal Description: US SURVEY 3043 LOT 13 PART 1 T10N R2E SEC 18 Parcel ID: 075-092-27
If more than 1 septic system on lot: COSA Checklist # _of _ Structure served by this system _
A. WELL DATA
❑ Well log is filed with Onsite (or attached)
Water storage tank volume NA gallons
Date drilled CIRCA 1973
Well disinfected for coliform test? ❑ Yes ® No
Total depth *56 ft
® Coliform bacteria is Negative
Cased to UNKNOWN ft
Nitrate 0.991 mg/L ❑ Nitrate less than MRL (ND)
® Sanitary seal is functioning correctly
Arsenic ug/L ® Arsenic less than MRL (ND)
® Wires are properly protected
WN
Casing height (above ground) 18+ in.
Collected by
Date of flow test for COSA 10/27/2020
Static water level at beginning of test 32 ft.
Date of Sample 10/27/20
Well production at time of test 4.4 gpm
Comments *PER OWNER
B. TfkNu DATA - NA
Age of tank(s)
Tank type/material
Measured operating fluid level in septic tank
❑ Standpipes/foundation cleanout per record drawing
Date of pumping
D—.ABSORPTION FIELD DATA - NA
Which systeted (date installed)
❑ ALL standpipe present per record drawing
Total measured depth from grad4 —ft
� (max)
Measured depth to pipe invert from grade;--- ft (min)
❑ N/A – pressurized field
❑ Monitor tubes go to bottom of effective. If not, state
depth into effective
❑ Code -required soil cover over field
❑ System presoaked
(Required if vacant for greater than 30 days prior to
date of test)
Gallons introduced gallons
Comments/Deficiencies:
C. LIFT STATION
❑ Required maintenance completed
Age of lift station years
Lift station material
Commet7t .
Adequacy test date
Results ❑ Pass For bedrooms
Fluid depth prior to test in
Water added gal
New depth _ in
�Elapsed time min
Final fit�idepth in
Absorption rate` g.qd
Any rejuvenation treatmeri-¢past 12 months)
If yes, enter date 1``
E. SEPARATION DISTANCES
From Private Well on Lot to: (Please enter distances if less than required or if community well)
Septic Tank/Lift Station on Lot > 100'
® Yes
if No ft
Community Sewer Manhole/Cleanout > 100'
® Yes
if No _ ft
❑ Yes
if No NA
ft
❑ Yes
if No *50+
ft
Neighboring Tank > 100'
® Yes
if No
ft
Private Sewer/Septic Line > 25' ❑ Yes
if No
*11+ ft
Absorption Field on Lot > 100'
❑ Yes
if No NA
ft
Holding Tank > 100' ® Yes
if No
ft
Neighboring Absorption Fields
> 100'
Animal Containment > 50' ® Yes
if No
ft
® Yes
if No
ft
Manure/Animal Excreta Storage > 100'
Community Sewer Main > 75'
❑ Yes
if No *50+
ft
® Yes
if No
ft
Rrom Septic/Holding Tank on Lot to: (Please
enter
distances if less than required)
Building cLundations > 10'
® Yes
if No
ft
Surface Water > 100' ® Yes
if No
ft
Property Line > 5'-,,11-1
® Yes
if No
ft
Wells on Adjacent Lots:
Absorption Field > 5'
Yes
if No
ft
Private Wells > 100' ® Yes
if No
ft
Water Main > 10'
® Ye-s,"'
No
ft
Community Wells > 200' ® Yes
if No
ft
Water Service Line > 10'
® Yes
if Nb-,,
ft
If septic tank is under driveway comment
below
From Absorption Field on Lot to: (Please enter distanc
Building Foundation > 10'
® Yes
if No ft
Property Line > 10'
® Yes
if No _ ft
Water Main > 10'
® Yes
if No ft
Water Service Line > 10'
® Yes
if No ft
Surface Water > 100'
® Yes
if No ft
F. ENGINEER'S COMMENTS
ss than required)
If absorption field is under driveway comment below
Wells on'- Aent Lots:
Private Wells > 10r® Yes if No —ft
Community Wells > 200N Yes if No
*WELL WAS DRILLED CIRCA 1973 & SEWER INSTALLED IN 1987. MET CODE AT DRILLING & ADEC WAIVERS
ISSUED (8621 -WA -078) FOR SUBSEQUENT SEWER. SEE ATTACHED DOCS (ADEC & USKH).
G. ENGINEER'S CERTIFICATION ,•��.�'�������
1 certify that l have determined through field inspections and review AW,t�Q`.: •' • • •�����
of Municipal records that the above systems are in conformance ��.' •;� I
with MOA COSA guidelines in effect on this date.
..•. a.... .. •�
' Curtis Huffman • •.' .
CE 128991
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ALASKA WATER &
WASTEWATER
PHONE NO.
: 9073383246
- 12, 99 ti£RI) 1 :43
10' skNiTAR'f 7 �
5w6R EASE
MENT
Vol R /w
�EAS�McNTY16LOT 13G
\� LOT 13 H i
\ , ���yST�euCr
t to T 14
LOT 12B
Mar. 12 1999 01:18PM PS
t
E•,
l
FROM ALASKA WATER & WASTEWATER PHONE NO. 9073383246 Mar. 12 1999 0
l9�R 1`. :d.y attt�� E\;;11ERI1
LULL SHEMELD, COVE&h
U
j7Qiophone! (9071
i
ANCFiORAGE/4lESTERN OisTRICi OFFICE437 E" STREET 274-2533
ANCHORAGE, ALASKAWiTE 03
October 24.
U.S`K.H.2
2525 "Ar' Street
Anchorese, Alaska 99503
i StiBJEc�: Waiver Horizontal Separation botveen Well and �wgr
Main. Girdwood Sewer L.J.D. 60-3, Lot 19 of
} U.S.S. 3042, Girdwood. Alaska {8621—LJA-078)
Dear Sir:
e5t and
The Department rt�.iaivesd tha horizontal separation the subject weivap ubetween
hereby condi
ue115 and sewer main to the f0ll0w"S'
Wei 1 #,, to Sower Bair,, Lots 13A & 81; 50 ft •
0411 to Sewer Main, Lot 13Ft 65 ft -
Well to Sewer Clain, Lot 13H; 90 ft+
The waiver is conditionally oerP10Ov198sOd uarecfullYnimplerneatadias
as addressed in t
stated,
If You have aanyelqu
ePhorieonumber'eaffie contact mike Lewis at the
above address
SincerslY+
8teweh (,!. 9, P.E.
district nsineer
SWFlmsm
13ECEIVED
-OCT 3 1 lWi
•A%h. Wate" & waslftvOer
tm�l te*;to 014.
.`ALASKA WATER & WASTEWATER PHONE NO. 9073383246 Mar. 12 1999 01:17PM P3
i - GHEI'dEERI�+,;
Land Surveying ���pfannin�
io.Arohttecture pn9lneering
p� horage, ASaska 0503 (007) 276424:
2515 "A„ IV001 1 5
Octobee 10, 1985
' •rl.•--Its{� �'•ty
Mr. Steven Eng, P.E.
Alaska Department of
Environmental Conservation
437 "E° Street
suite 240 '
Anchorage, Alaska
9asa1 � �• ; �; ;
Re.. GirdWood Sewer L.I.D. #50-3
On behalf of the Anchorege Water and Wastewater Utility, + are submitting this
proposal for a n Cher Lf1 D. referencedlabove which ns for four
we discussed witht 13 Of
You on
U.s.S. 3042, in the
October 9, 85 attachedalots in question are tlumbared'13F, 13G, 13H and 131 an
are shown on
As shown on the map, wa aro proposing to extend the $° sewer lateral running
along the Southwest boundary line of Lot 13A one hundred (100) feet to serve the
sinFour lots in
t question.
trust .a n w wellare al Be at theosouthwesto. end nOfnthat lot, Which the exiSting 0would
Lot 1 well
at Lely ninety (90) feet between the new well
result in a separation of app
an is
and theto hmeet ADEChregul ati onsh 1100tended feet) and Sewer.
adequatemanole at te end s larger try for than thea€mft.Y
(5(}) foot separation provided in two adjacent waiver cases swells on Lots 13A
and 1381).
We are proposing this waiver contingent on {1) obtaining the agreement oensionf all
with
four of the lot owners involved; (2) constiructi ng the sewer p ext
and heat shrink
mechanical manholes, Field Lock Gasket Joint ductile
sleeves.
l di cased and
i n yoimplementation
r e et r iso us a May
1986;5 and,t ( 3) discontinuation ion ection 8 of the
Indicated
of onset ssewagasdisdnsas possible,
Thank
the 'four lots, and their connection ca
the propos
'frank You for your consideration of this request.
Sinter�iYy•
Terry L.• Waldo e, P -E.
project Manager
TLW/rcl
cc: Don Keefer, AWWU
6aoM Q. Vrrietn. 1' E � tea yen shg4Qtt Ir P �• t•S. • Eon 0 xulrla Y ti
.Wwq A piwnl, h.IA + Gary H, Paht, A.i A I fthmo + May*$ •...
i FROM ALASKA WATER & WASTEWATER PHONE NO. 9073383246 Mar. 12 1999 0
I ?
4kR -,: 9aliRl, l..a. aNU E1131NHRIt TEG SbI-�8?i
A luLi SHEFFIELD, GOVERA
Tolophpno M071
E v �lE' �N V10N1dE%TA11, CONSERV .'> 10N
I
t ANCHORAGE/WESTERN DISTRICT OFFICC
437 'E' STREET. SUITE 303 274-2533
ANCHORAGE, ALASKA 99501
October 24. 1985 ,
"� : �• C
tf tom.
U.s.K.H.
2525 ..A" Street
Anchorage, Alaska 99903
i
SUBJECT: Waiver Horizontal Separation between Well and "§,ewer
Main, Girducad Sewer L,I-D, 60-3, Lot 13 of �„
j U.S.S. 3042. Sirdwood. Alaska (8621—WA-078)
Dear Sir:
nt has reviewed the subject waiver request and
The D9PartmB
hereby cdnditicngliy naives the horizontal separation between
wells and sewar main to the fallowin9i
Well1k to Sewer gain, Gots 13A 8 Si: 50 ft.
Wotl to Surer Main, Lot 13F1 65 ft -
E Well to Sewer Main, Lot 13H; 40 ft+
es
The addressads innyouraOCtoberP10, 1985PrOvOd uare afully ni
imPlementedas
as
stated,
if
aboveaddressoany que stione stease contact dike Lewia at the
aba r
number -
Sincerely,
tSYei1 i�•9! P.E.
District ngineer
SUE/msm
' `RECEIVED
-OCT 3 1 AM
•A'ttGh. Wator & Wasiftuaw
jlnw�wo m.